Healthcare Provider Details

I. General information

NPI: 1477835668
Provider Name (Legal Business Name): LYDIA S SUN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 356057
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-6060
  • Fax:
Mailing address:
  • Phone: 206-598-6060
  • Fax: 206-598-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60145730
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60145730
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: